DHBs fail clinical leadership tests

“District health
boards are too busy telling their Minister what they think
he wants to hear and are failing to provide the leadership
New Zealand’s health system needs,” said Mr Ian Powell,
Executive Director of the Association of Salaried Medical
Specialists (ASMS), today.

“We’ve surveyed our
members working in public hospitals two times now, and both
times we’ve found that not enough is being done to provide
senior doctors and dentists with opportunities for clinical
leadership,” he says. “A few DHBs and chief executives
are doing well, and they’re to be commended, but most are
really failing.

“Frankly, they’re missing the point of
clinical leadership. It’s not a luxury or a nice-to-have
but an essential part of a safe modern health system.
It’s a no-brainer to involve a highly skilled professional
and committed workforce in leadership decisions about the
services they then have to deliver.”

The first ASMS
survey was done in August and September 2013, and found that
most hospital specialists (63%) simply did not have enough
time to take part in clinical leadership activities.

The
second survey carried out at the end of last year, and
reported in the latest issue of the ASMS magazine The
Specialist, aimed to better understand the performance of
individual DHBs, chief executives and hospital managers on
the issue of clinical leadership.

“The findings make for
grim reading,” says Mr Powell. “There’s significant
variation between the DHBs and chief executives performing
well and those at the bottom of the class, who really need
to be sent to the principal’s office for some remedial
homework.”

He says the failure to engage with hospital
specialists and involve them more fully in decision-making
is not just an issue for the people managing New Zealand’s
hospitals; it can also be sheeted home to the
Government.

“The broader political failure to invest in
the specialist workforce has resulted in entrenched
shortages which have become the norm in the health sector.
One of the consequences of this is an increased workload for
senior doctors and less time to get involved in anything
else. Improving clinical leadership was once a flagship
government policy. Now it is a policy failure.”

Mr
Powell says DHBs have been saying all of the right things
about clinical engagement for several years now but the two
membership surveys show the reality is somewhat
different.

“DHBs need to lift their game in this area as
it has flow-on effects for patients, specialists and health
care delivery. It’s not enough for them to tell the
Government what it wants to hear about clinical engagement
– they need to provide some real leadership for the
sector,” concluded Mr Powell.

The latest survey results,
just published, found:

DHB ratings - 30% of members
surveyed thought their DHB was genuinely committed to
distributive clinical leadership, 47% felt their DHB was
not, and the remaining 23% were not sure. Just two DHBs
scored higher than 50% - Canterbury (62%) and Lakes (56%).
The worst results were recorded for Wairarapa, Hutt Valley,
Southern, Bay of Plenty, and Auckland DHBs.Chief
executive ratings – members rated their chief
executive’s commitment to enabling effective distributive
clinical leadership in their DHB’s decision-making.
Overall, 12% thought their chief executive was working to a
great extent to do this, 46% believed to some extent, 18% to
no extent, and 24% said they didn’t know. Canterbury/West
Coast DHBs’ Chief Executive David Meates was the standout
performer while 12 other chief executives received the
lowest ratings.

DHB senior managers – by and large these
people were rated lower than the chief executives they
report to. Just 8% were thought to be enabling clinical
leadership in decision-making to a great extent, 45% to some
extent, 25% to no extent, and 22% of members were not sure.
When the ‘great extent’ and ‘some extent’ categories
are combined, the top performing senior managers appear to
be in Hawke’s Bay, Canterbury, Lakes, Nelson Marlborough
and Taranaki DHBs. The poorest performers are South
Canterbury, Bay of Plenty, Southern, Wairarapa and the Hutt
Valley DHBs.

DHB middle managers – these rated even
lower, with just 7% of members saying they enable effective
distributive clinical leadership to a great extent, 43% to
some extent, 32% to no extent, and 18% saying they do not
know.

Human resource managers – these performed worst in
the survey, with a national average rating of just 2% for
‘great extent’ 19% for some extent, and 40% considered
not to be enabling distributive clinical leadership at all.
Another 39% of members said they did not know if their HR
manager was enabling clinical
leadership.

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